Ward_X

~850 bed hospital here. If it's around shift change, normally the previous shift has a few techs stay to help with the need. Otherwise, you kind of deal with the traumas as they go and with the staff you have. As a safety net, if it's an off-shift, we do have a supervisor on call. We honestly seem to have at least one MTP a week, supplied by a minimum of at least 3(ish) techs.

I agree, and at this point, as long as it isn't being reduced to the nurses it should be okay to absorb onto other existing positions

As far as the specific membrane properties of each bag, I can't name specific biomedical engineering reasons. However, they are all a different size and texture for a reason. Plt bags allow optimal exchange for platelets when they're lying flat on their rotators; it comes down to clumping/aggregation cascade... But I reiterate the above comments and I would look at the manuf. directions

I agree -- you have to make it hard to do the wrong thing (and thus easy to do the right thing). I've heard stories during a nearby terrorist event that coolers of blood were just going out everywhere and anywhere; whoever came down seeking blood got it. Tragedy and mistakes, unfortunately, are what drives policy adjustment. Individually assigned coolers and labels was the fix for that one, and it seems more compact and more difficult to switch pts compared to a shared fridge, but who knows. Chalking dangerous misses to "oh, that's just how humans be" seems problematic There can also be glitches and write-over problems with XM status when the doctors are attempting to assign units to their pts, especially in regards to emergency released units. We have interface problems with HCLL to EPIC -- it's fairly easy to use an UNXM record to then try to EXM.

What's aggravating is when the pt has a historical type and you're waiting for a current sample, but you still have to give type O blood and you start running through your supply because the floor is being slow. Otherwise, what if the sample was WBIT, or some other factor that means the typing could be incorrect? In that sense, if they're asking for emergency released, the pt is still getting type O until that new T/S is completed.

Its written in AABB News, April 2019, Vol. 21 Vol. 4 They definitely are trying to highlight it as an option; not many people are aware it's a thing.

Isn't there only restrictions on the packaging for products? ____ inches of insulation, ____ type of ice pack (whether wet or dry), etc. If the products arrive as following packed guidelines, would you need to check necessarily? Reagents received usually come with those temperature validating color-changing window cards. Interesting how a similar thing doesn't come with blood products...

A quick disadvantage is the need to ABO match, so just from an inventory standpoint, you're going to have to manage the fine balance in stock without wasting products by the end of the expiration date. How long do you keep the WB before storage and preservation becomes more difficult? Towards the end, would you end up separating it into components? Would you just be ordering low titer group Os? Advantage that I've read is that the platelets contained in WB are kind of a "bonus" product compared to just issuing 1:1. Furthermore, one WB containing 3 different types of products essentially reduces donor exposure because the WB is only from one source. Whether that can therefore reduce immunological responses and antibody formation is another question. There was a review published in December of 2018 that outlines some of your bullet points: Massive transfusion of low-titer cold-stored O-positive whole blood in a civilian trauma setting. Transfusion, Epub Dec 27, 2018.

I've seen have aliquoted units on hand ready to go that are replenished when needed/expiration. Firstly, there's an emergency release prep bag with a pre-filled out emergency issue slip with irradiated units that just need a pt identifier slapped on it before send out. Secondly, there's also other aliquots that can be irradiated and issued per need.

Yeah, we're kind of the same. In terms of standard T/S testing and the cutoff for acceptability, we just throw it on our IH and if it doesn't like the sample it's just done manually. Usually the contrast distinction chromatically is the problem that triggers a rejection/difficulty in testing via machine. Only when there's hemolysis in a post-transfusion rxn specimen is another redraw requested...

It seems to me that the only time hemolysis comes with an acceptance/rejection gradient is with washing RBCs (at the institutions I've seen). At least for that there is a color hue chart to match. If the gel can't discriminate between the layers, it tends to just call it DP and it gets sent for tube testing. I've never seen a sample rejected based on hemolysis... Is there literature to dictate a cutoff?

I thought this role was being shifted specifically to TSOs (transfusion safety officers), who acted as a sort of clinical pt care/laboratory liaison? Unless this is still a relatively new position... I know they were attempting to popularize it in an article within one of the immunohematology journals of this year.

We have a male SSP historically A POS with a transfusion rxn to an AB POS platelet. The current sample was tested in gel, with cards that are DVI-. The pt also had a previous TRXN also to a plt that was Rh POS. The rxn displayed a weakly positive post-DAT, with the followup pre-DAT significantly more positive. The resultant ABORh in tube on both the post and the pre samples are A NEG rather than Rh POS. Our bench reagent is a human-derived monoclonal Anti-D. My question is, how can we have such a huge discrepancy between gel and tube for testing for D? Is this an anti-D, or is there a biochemical answer for the reactivity seen with the mechanism of bead agglutination in the column?

Even if you protect this on one end (let's say you keep one mobile device or camera in the lab at all times that does not leave the lab), you cannot guarantee it's protected on her end. What if she loses her phone, or her device gets hacked? You'd have to keep all pt identifiers out and not send it along with the photo. But then in that case, I feel like you could easily mix up pts and lose information in translation. Based on your phrasing, it seems like if you find a suspicious cell and want clarification, that you send a general picture and they could provide guidance. It does not sound like they're using it at the diagnostic level. At least, I would hope a healthcare professional of that caliber is not diagnosing over a cell line.

I just answered this question. My Score PASS